title: Complication with intraosseous access: scandinavian users' experience.
abstract: BACKGROUND
  Intraosseous access (IO) is indicated if vascular access cannot be quickly established during resuscitation. Complication rates are estimated to be low, based on small patient series, model or cadaver studies, and case reports. However, user experience with IO use in real-life emergency situations might differ from the results in the controlled environment of model studies and small patient series. We performed a survey of IO use in real-life emergency situations to assess users' experiences of complications.
  
  
  METHODS
  An online questionnaire was sent to Scandinavian emergency physicians, anesthesiologists and pediatricians.
  
  
  RESULTS
  1,802 clinical cases of IO use was reported by n=386 responders. Commonly reported complications with establishing IO access were patient discomfort/pain (7.1%), difficulties with penetration of periosteum with IO needle (10.3%), difficulties with aspiration of bone marrow (12.3%), and bended/broken needle (4.0%). When using an established IO access the reported complications were difficulties with injection fluid and drugs after IO insertion (7.4%), slow infusion (despite use of pressure bag) (8.8%), displacement after insertion (8.5%), and extravasation (3.7%). Compartment syndrome and osteomyelitis occurred in 0.6% and 0.4% of cases respectively.
  
  
  CONCLUSIONS
  In users' recollection of real-life IO use, perceived complications were more frequent than usually reported from model studies. The perceived difficulties with using IO could affect the willingness of medical staff to use IO. Therefore, user experience should be addressed both in education of how to use, and research and development of IOs.
authors.affiliation: Copenhagen University Hospital, Department of Pediatric Anesthesia, Rigshospitalet, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Hallas
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brabrand
authors.forename: Lars
authors.initials: L
authors.lastname: Folkestad